What
Is a Cold Knife Cone Biopsy?

Cold knife cone biopsy is a surgical procedure used to remove
tissue from the cervix. The cervix is the narrow part of the lower end of the
uterus and terminates in the vagina. Cold knife cone biopsy is also called
conization. This procedure removes a large cone-shaped piece of the cervix to
look for precancerous cells, or cancerous material.

Cold knife cone biopsy is performed under a general or regional
anesthetic. The surgeon uses a scalpel to remove the cervical tissue.

Reasons
for Cold Knife Cone Biopsy

Cervical biopsies are used as both a diagnostic tool and a
treatment for cervical precancer and cancer. Abnormal cells that appear on a
Pap test may require further examination. Your doctor will remove the abnormal
cells from your cervix to determine if you have cancer, or if the cells are
precancerous.

There are different types of cervical biopsies. Punch biopsy is a
less invasive kind of cervical biopsy that removes small areas of tissue. Your
doctor may choose a cold knife cone biopsy if they’re not able to gather enough
tissue through a punch biopsy. Cold knife cone biopsies let your doctor take a
larger amount of tissue. This is especially important if you have already been
diagnosed with cervical precancer or cancer. Sometimes all of the cancerous
material can be removed during one cold knife cone biopsy.

Preparing
for Cold Knife Cone Biopsy

Many women undergo cold knife cone biopsy under a general
anesthesia, meaning they’re asleep for the procedure. Those who have preexisting
health conditions such as heart, lung, or kidney disease might
have increased risks while receiving general anesthesia. Be sure to discuss
your health history and any previous reactions to anesthesia with your doctor. Risks
of general anesthesia can include:

infection

breathing difficulties

stroke

You may be given a regional anesthetic instead. Regional
anesthesia numbs you from the waist down, but you remain awake. You won’t feel
any pain under either general or regional anesthesia.

Fasting for six to eight hours before the biopsy can help prevent
nausea. Nausea and an upset stomach are common reactions to anesthesia. Abstain
from sexual intercourse for 24 hours before the test. Don’t insert anything
into the vagina for 24 hours before your biopsy, including:

Bring sanitary pads with you to wear after the biopsy. Ask a
family member or friend to accompany you so they can drive you home.

The
Cold Knife Cone Biopsy Procedure

The entire cold knife cone biopsy takes less than an hour. You’ll
lie on an examination table with your feet in stirrups, like a regular
gynecological exam. Your doctor will insert an instrument called a speculum
into your vagina to push apart the vagina’s walls and keep your vagina open
during the biopsy. After you’ve been sedated with either a regional or a general
anesthetic, your doctor will complete the biopsy.

Your doctor will use either a surgical knife or a laser to remove
a cone-shaped piece of cervical tissue. Your doctor will use one of two options
to control bleeding in the cervical. They might cauterize the area with a tool
that seals the blood vessels to bring the bleeding under control. Alternately, they
might place conventional surgical stitches in your cervix.

The tissue that was removed from your cervix will later be
examined under a microscope to determine the presence of cancer. Your doctor
will notify you of the results as soon as possible.

Cold knife cone biopsies are usually performed as an outpatient
procedure. The anesthesia wears off within a few hours. You can go home the
same day.

Risks
of Cold Knife Cone Biopsy

The risks associated with cold knife cone biopsy are minimal.
Infection is a possibility as with all surgical procedures. Minimize the risk
of infection by taking care of yourself after the biopsy:

Wash your hands before and after using the
bathroom.

Avoid using tampons for four weeks after your
biopsy.

Avoid douching.

Change sanitary pads often.

Scarring of the cervix and incompetent
cervix are rare but are potentially serious risks. Cervical scarring can
hamper your efforts to become pregnant and may cause difficulties in reading
Pap smears. An incompetent cervix occurs when a very large area of the cervix
has been removed. The wide area of tissue removal can increase your chance of
premature delivery during pregnancy.

Cold
Knife Cone Biopsy Recovery

Recovery from cold knife cone biopsy can span several weeks. You’ll
most likely experience cramping and bleeding intermittently during this time.
Vaginal discharge can range from red to yellow in color, and it may be heavy at
times.

Notify your doctor if you develop any of the following, as these
may be signs of infection:

fever

chills

discharge that smells foul

mild-to-moderate cramping, progressing to severe
pain

Notify your doctor if you have any of the following symptoms, as
they may be signs of a blood clot:

chest pain

difficulty breathing

swelling, redness, or pain in your legs

Avoid lifting heavy objects or physical strain for four to six
weeks after a conization procedure. You should also refrain from having sexual
intercourse during this time to allow yourself to heal.

Schedule a follow-up appointment with your doctor six weeks after
your biopsy.

Long-Term
Outcome and Expectations

Cold knife cone biopsy is a highly effective way of diagnosing
abnormalities of the cervix and treating early stages of cervical cancer.
Stages 0 and IA1 of cervical cancer are sometimes treated with cold knife cone
biopsy. For these very early stages of cancer, the biopsy often is able to
remove the cancerous area entirely.